Metastatic prostate cancer to the testis as an initial presentation: Management review and outcome

Abstract

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Metastatic prostate cancer to the testis as an initial presentation is a rare condition. Though it has been noted to be associated with poor prognosis, no treatment guideline is currently available aimed at improving the outcome. This report reviews the management of a case and its outcome. Case Report: A 47-year-old male presented with a painless swelling of the left testis and rectal discomfort of three weeks duration. He had a strong family history of prostate cancer. Examination of the scrotum revealed a left non-tender testicular mass 7x5 cm that was hard with irregular surface. A digital rectal examination revealed an enlarged and nodular prostate and seminal vesicle involvement. A histological and immunohistochemical analysis of the prostatic biopsy and specimen from an inguinal orchidectomy of the left testis confirmed a metastatic prostate cancer to the testis. After three months of combined androgen deprivation therapy, he developed progressive obstructive urinary symptoms, severe pain in the anus, and a rapid increase in size of the prostate gland being castrate resistant. He underwent three dimensional conformal radiotherapy to the whole pelvis followed by seven cycles of docetaxel based chemotherapy. Nineteen months following diagnosis, his PSA was 1.86 ng/ml. Despite normal tPSA levels, there was clinical failure with development of bilateral lower limb swelling from para-aortic lymphadenopathy at two years. The patient died after two additional cycles of docetaxel chemotherapy. IJCRI publishes Conclusion:In a young patient with prostate cancer presenting initially with testicular metastasis, aggressive management strategies as pertains for castrate resistant cases need to be initiated early to improve outcomes.